Impact of comorbid personality disorders on psychotherapy for post-traumatic stress disorder: systematic review and meta-analysis

Abstract

Background: Although personality disorders are common in PTSD patients, it remains unclear to what extent this comorbidity affects PTSD treatment outcome. Objective: This constitutes the first meta-analysis investigating whether patients with and without comorbid personality disorders can equally benefit from psychotherapy for PTSD. Method: A systematic literature search was conducted in PubMed, EMBASE, PsychINFO and Cochrane databases from inception through 31 January 2020, to identify clinical trials examining psychotherapies for PTSD in PTSD patients with and without comorbid personality disorders (PROSPERO reference CRD42020156472). Results: Of the 1830 studies identified, 12 studies reporting on 918 patients were included. Effect sizes were synthesized using a random-effects model. Patients with comorbid personality disorders did not have significantly higher baseline PTSD severity (Hedges' g = 0.23, 95%CI −0.09-0.55, p = .140), nor were at higher risk for dropout from PTSD treatment (RR = 1.19, 95% CI 0.83-1.72, p = .297). Whilst pre-to post-treatment PTSD symptom improvements were large in patients with comorbid PDs (Hedges' g = 1.31, 95%CI 0.89-1.74, p < .001) as well as in patients without comorbid PDs (Hedges' g = 1.57, 95%CI 1.08-2.07, p < .001), personality disorders were associated with a significantly smaller symptom improvement at posttreatment (Hedges' g = 0.22, 95%CI 0.05-0.38, p = .010). Conclusion:Although the presence of personality disorders does not preclude a good treatment response, patients with comorbid personality disorders might benefit less from PTSD treatment than patients without comorbid personality disorders. Impacto de los Trastornos de Personalidad Comórbidos en la psicoterapia para el Trastorno de Estrés Postraumático: Revisión Sistemática y Meta-análisisAntecedentes: Aunque los trastornos de la personalidad son comunes en los pacientes con TEPT, sigue sin estar claro en qué medida afecta esta comorbilidad al resultado del tratamiento del TEPT. Objetivo: Este constituye el primer meta-análisis que investiga si los pacientes con ysin trastornos de la personalidad comórbidos pueden beneficiarse de la misma forma de la psicoterapia para el TEPT. Método: Se realizó una búsqueda sistemática de literatura en las bases de datos PubMed, EMBASE, PsycINFO yCochrane desde su creación hasta el 31 de enero de 2020, para identificar estudios clínicos que examinaron psicoterapias para el TEPT en pacientes con TEPT, con ysin trastornos de la personalidad comórbidos. (referencia PROSPERO CRD42020156472). Resultados: De los 1830 estudios identificados, se incluyeron 12 estudios, que reportaron 918 pacientes. Los tamaños de efecto fueron sintetizados usando un modelo de efectos aleatorios. Los pacientes con trastornos de la personalidad comórbidos no tuvieron una severidad del TEPT basal significativamente mayor (gde Hedges = 0.23, IC 95% -0.09 -0.55, p= .140), ni tuvieron un mayor riesgo de abandono del tratamiento del TEPT (RR=1.19, p= .297). Mientras que la mejoría de los síntomas de TEPT pre ...

Psychiatric comorbidities in older adults with posttraumatic stress disorder: A systematic review

“…Comorbidity rates of personality disorders, suicidal ideations, intentions and attempt, and eating disorders in older adults with PTSD have been studied in one out of five articles (20.0%). Personality disorders often co‐occur in PTSD (comorbidity rate 22%–26% in adults) 44 . The current finding of only one study investigating the comorbidity rate of personality disorders in older adults with PTSD is disappointing.…”

“…Personality disorders often co-occur in PTSD (comorbidity rate 22%-26% in adults). 44 The current finding of only one study investigating the comorbidity rate of personality disorders in older adults with PTSD is disappointing. Core features, such as disturbed interpersonal relationships and emotional dysregulation, can persist into old age, contributing to a high disease burden, including psychosocial impairment and elevated suicide risk.…”

Self‐rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care

“…Although our results add to the evidence base arguing in favour of carrying out evidence‐based, trauma‐focused treatment in the case of comorbidity, this does not mean that PD should be disregarded in PTSD treatment. For example, Snoek et al (2021) did report smaller treatment gains after treatment for those with PTSD and comorbid PD, which may increase risk of relapse. Adding concurrent PD treatment to trauma‐focused treatment may enhance treatment effects for both disorders.…”

“…Some studies found no association between PD and PTSD treatment outcome (Clarke et al, 2008; Ehlers et al, 2013; Markowitz et al, 2015; van Minnen et al, 2002; Walter et al, 2012), while other studies reported a negative effect of PD comorbidity on PTSD treatment outcome (Sripada et al, 2019; Zayfert et al, 2005). Snoek et al (2021) performed a meta‐analysis of 12 studies on the moderating effect of predominantly interview‐rated PD on PTSD treatment outcome. Symptom improvement for both groups following treatment was large, but comorbid PD was associated with a significantly smaller PTSD symptom improvement and lower end‐state functioning at post‐treatment (Δ Hedges' g = 0.22, 95% CI = 0.05–0.38, p = .01).…”

Recent advances in research on personality disorders

“…Last but not least, comorbid personality disorder has been studied as a predictor for treatment efficacy and dropout in treatments, especially with patients treated for post-traumatic stress disorder (e.g. Snoek et al, 2021). In the last study in this Special Issue, van den End et al ( 2023) investigated whether co-morbid personality disorder had negative effects on treatment outcomes for post-traumatic stress disorder.…”